| Author |
Message |
Dwongwhey
Registered User
Username: Dwongwhey
Post Number: 47
Registered: 10-2001
| | Posted on Wednesday, January 30, 2002 - 10:50 am: | |
Seems to me that the simple solution for all the carriers and DRP contractors is to hire some of the out of work cat adjusters with licenses in hand and no work to work for or as contractor/licensed adjusters. That should provide some much needed jobs, legitimate compliance with the licensing requirements of those states which require adjusters to be licensed, while silencing the rather silly demands of those who want to go back to the way things were in the Stone Ages.
I only wish some of you could back up far enough to see the forest from the trees. I think you are all barking up the wrong tree with regard to why this industry is failing and so many are out of work. |
Ajackson
Registered User
Username: Ajackson
Post Number: 102
Registered: 12-2000
| | Posted on Tuesday, January 29, 2002 - 7:27 am: | |
It's things like this that make me happy. Happy that I finaly graduate Law School May 8 and take the bar in July. Look out SF, Adjuster/Lawyer is on the way. Here in Alabama, companies have a duty to properly investigate the claim. How do you properly investigate the claim if you never show up. Looks like they may have to explain this contractor / adjuster postition they have created.
I'm going to shoot this thread over to a few of my MOLD LAWYER buddies. They should have a field day with this. |
Wscook
Registered User
Username: Wscook
Post Number: 30
Registered: 1-2001
| | Posted on Monday, January 28, 2002 - 11:41 pm: | |
Jim
This is a new wrinkle provided by SF to avoid their involvement in the decision to retain a preferred vendor. Note how many times the directives use the word "you or your" and how they never mention "we". SF has shifted the process so that it is the insured that is selecting the SF preferred contractor and making the decision to hire. Since it is the responsibility of the insured to present the claim, any mistakes will fall on the insured's failure to present the claim. You can bet your last bushel of corn against my coming basket of pineapples that a contractor that includes all of the insured's entitlements (if he knows them) will not be on next years premium service program. One of our salvations is that SF will probably make all vendors buy books and attend their certification classes. Perhaps some SF certified adjusters can sell them the books that they bought about 12 months ago, that now appear to be no longer needed. Who will help the client with his contents and APS coverage and advise him on his ALE? I hope that when the client’s problems with the SF preferred vendors arise that they seek the assistance of a qualified public adjuster or property attorney to look after their claim rights and interest.
William S Cook
Public Adjuster
|
Jimlakes
Registered User
Username: Jimlakes
Post Number: 59
Registered: 12-2000
| | Posted on Monday, January 28, 2002 - 10:09 pm: | |
TO ALL,
Here is the message. If you don't think this is taking food off your table then give me a call, I want to sell you some beach front property in AZ.
Home/Building Repairs
SF Premier Service® Program
You are a valued policyholder. If you ever suffer a covered building loss, SF Good Neighbor claim service provides the SF Premier Service program to help you get your damaged building property repaired.
SF Premier Service provides a list of participating contractors that can complete your needed restoration. If your loss is eligible, you decide whether to use this optional Good Neightbor service and which participating contractor will perform your repairs.
SF Premier Service program offers these benefits:
The contractor guarantees his/her labor workmanship on building repairs for up to five years.
No need to search for a contractor.
You select a contractor from our list of participating contractors.
You authorize the contractor to begin repairs.
You authorize payment directly to the contractor once repairs are completed.
Material Suppliers participating in the program will be paid directly by SF.
If your covered building loss is eligible for the SF Premier Service Program and you elect to use this service, here's how it will work:
You contact your SF agent to report the loss to your property.
You choose a participating contractor.
Your claim representative can help you choose and will notify your selected contractor of the assignment.
Your contractor will contact you for an appointment to examine and estimate the damage.
You authorize the contractor to begin repairs.
You authorize payment directly to the contractor when repairs are completed. You pay your deductible to the contractor.
If you have any questions, please contact your State Farm agent or claim representative.
Note: The SF Premier Service program may not be available in all service locations. Please contact your SF Agent or claim representative to review the current service areas.
Gee is this isn't ADJUSTING THE CLAIM, then someone correct me and tell me what it is!! |
Toms
Registered User
Username: Toms
Post Number: 14
Registered: 12-2001
| | Posted on Monday, January 28, 2002 - 8:53 pm: | |
}I was watching Television and on comes a commercial during Rams playoffs.It was State Farm. They were advertising and I have noticed several times and stations since,about their Preferred Contractor program. I have tried to place a link here for you to review. It tells exactly what happens and WHY THE ADJUSTER IS NOT INVOLVED, in this process. This should answer anyones questions as to Contractors versus Adjusters and why a lot of people have not and are not working. When the "Cane" hits, I will not work for them,even if the do pay 4.5% of the gross loss as a fee schedule.(as in Cane Andrew And,remember,how rich we during that home run)
Please review and make your own decision.
The site is www.statefarm.com/claims or link below
statefarm.com® | Claims |
wscook
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:34 am: | |
Dear Mr. Whey
Please contact Lynn at the Hawaii Department of Insurance phone number 808 586 2790 for a clarification and your edifcation of the departments position regarding contractor work being supervised by any Hawaiian licensed adjuster. She said it did not matter if it were General Adjuster, sargent adjuster or private adjuster supervising his activities he has to be licensed to do the business of insurance in Hawaii. I know that the state is made up of many little islands and you may be on an island where rules are different. But on the main island it appears that you are ignorant of the laws according to Lynn. Based on that response from the big island's DOI please send my bushel of pineapples to
William S Cook (Public Adjuster)
14212 Wing Foot Rd
Orlando, Fl. 32826
Should you turn up in Florida on any loss where I am involved be prepared to expect a visit from a Florida DOI investigator to convince him of the errors of our legislature in drafting our laws as the are currently written.
PS
I did not give her your name to Lynn, so as an adjuster ignorant of the main island's laws you can continue the practice of supervising contractors on your island, especially when General Adjusters are involved. That practice is sure unfair to the underling licensed adjusters that must rely on their skills to produce an estimate. Why could an underling adjuster on your island not use a contractor for the same purposes on a small grass hut? |
John Postava
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:33 am: | |
As I said in my previous post, I do feel DRP's will be around for a long time. However, I do also believe that one, over the past 20 years I have seen DRP come and go (they go usually due to a couple of bad apples that get caught overcharging and a carrier VP closes the program and two, they are only involved in a portion of a carriers overall losses. I agree with Bill Cook, that we must be viligent that DRP contractors remain limited to scoping damages and report any illegal "adjusting" or "policy interpetation" activities (unless the contractor is an adjuster (luckily in Florida, adjuster licenses are not easy to obtain). Public adjusters are in a much better position to blow the whistle on questionable DRP contractors. If I, as an IA working for a carrier gives their DRP's a hard time out there, it can get very sticky and political for me if the claims managers believe very strongly in their DRP program. It will be VERY INTERESTING to see how Crawford and the ContractorConnection work together (my guess, and if there are more Bill Cook's out there, not very long). enjoy this thread, it is very important to all of us....(adjusters, public adjusters and software vendors.....) |
jlombardo
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:32 am: | |
Gentlemen---is the reason that licensed adjusters should handle the adjusting really that complicated????? Should we not get back to basics??? We adjusters are the eyes and hands of the insurance company as well as their ambassadors and the representatives of the INSURANCE POLICY. When we adjust a loss we do all of the above and we do it in such a fashion as to look out for the best interest of all involved--governed , of course by the policy. Even if we were acting as "appraisers only" we still have a greater burden to respond as above than does a DRP.
Remember the DRP egts paid by what they write----they get the job and maybe 20-25% profit. So that 3000.00 CAT loss is worth between 600-750 to them, whereas, that same claim would be worth between 150-180 to the IA......shall we let the fox guard the chicken coop---from the inside....Yes there are honest and talented DRP's but how long before they become complacent? How long before they add a little here and a little there???
How many DPR's can an inside claims adjuster supervise PROPERLY?
Most people fall into routines fairly easily....and become complacent.We as IA's can not afford to do that...example , this forum.
As far as comparing this with the approved auto shops, there is a whole lot of difference between a 30,000 auto and a 160,000 home. And it is not just money----remember every 1999 Camry that rolled off the line were built exactly the same ---with the wiring fastened to a panel in a certain way , etc. Now , how about homes.......especially ones that have been LIVED IN and modified.....etc., etc., etc.,
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wscook
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:31 am: | |
John
If your theories that DRP contractors (Simsol Customers) can do all that licensed adjusters (Simsol Customers) can do. It is likely that the DRP Contractor/unlicensed adjusters group will soon outnumber your licensed adjuster group. Every contractor that does the work of an adjuster representing an insurance company ultimatly takes the bread off the table of some independent adjuster. That licensed adjuster may have to spend his Simsol program money to buy bread for his family. That is not hogwash, but an economic fact.
Catastrophe adjusting vendors should see any support of DRP programs as another threat to the profitability of providing skilled trained adjusters to insurers for a fee and competition that completely avoids the scrutiny of insurance regulators. Most vendors would not welcome this unlevel playing field with the same open arms that you appear to embrace. As a public adjuster my problem is that the contractors have no obligation or duty to respond to any dispute that I may have with their submission to insurers. They have an agenda to serve the insurers (in hopes of getting the restoration work) sometimes to the detriment of an insured. The insured's often trust that the repairman sent by insurance company has some sort of claim related authority. Contractors/unlicensed adjusters often assume that role. If the insured calls a contractor to assess the damages for submission to insurers then I got no beef with that. The contractor is doing what he is licensed and trained to do. When he establishes the amount that insurers will pay he is in violation of the insurance licensing rules for adjusters and he should be fined as well as the insurers that sent him. You as a Florida licensed adjuster are required by the statutes to report any violations of the statutes by a licensee of the insurance department or else you are in violation of the statutes.
Perhaps the legislature will rewrite the statutes so that contractors can act as adjusters if it is such a good thing and will save the insurance companies some money. Until that happens I will continue to report all violations of the statutes to the department when I see them happening. I think that if enough adjusters had a concern for terminanting this illegal practice they will have more bread on their table in the future and will be able to buy the Simsol program for processing their files.
With no animosity to you or Simsol I wish you and your catastrophe and software companies prosperity in a continual reducing arena.
William S Cook
Public Adjuster
in Orlando |
John Postava
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:30 am: | |
From my vantage point as both the owner of an estimating software company and a catastrophe adjusting firm, it appears the DRP's in property are here to stay. They have worked sucessfully in the auto industry for years. Carriers can better control costs and, with today's advanced property and data mining solutions, can quickly audit estimates and determine leakage dollars in their building and contents losses.
Although there are thousands of property adjusters certainly qualified to write detailed estimates, contractors bring to the table a higher level of "percieved" credibility. For years, public adjusters and the law profession have tried to diminsh the credibility of "adjusters working for the company" with such terms as "don't sign ANYTHING" or "call us first". Well, all of their preaching has put question marks in the eyes of the average policyholder when it comes to dealing with staff and I.A's.
DRP's allow carriers to send in licensed contractors with no axe to grind. Actually, the larger the estimate they write, the more they earn. Policy holders understand this. Big Red is even running ads for the DRP on national televsion. Of course, it is up to the inside staff adjuster or DRP supervisor to interpet policy audit scopes of damage and estimate unit costs to rein in the contractor when necessary.
The DRP scenario does put both the IA and PA world in jeopardy. IA's don't get the claims and PA's lose their fees (i.e. why should I, as an insured with a loss, pay a public adjuster a fee when the contractor is doing it for free).
IA's and PA's might argue that you can't "trust" contractors. Hogwash! We have all dealt with knowledgeable insurance contractors that don't forget a toothbrush holder! The professional restorer knows his stuff. But, just like IA's and PA's, there are good, bad, honest and dishonest restorers. It is the job of the DRP's to separate the wheat from the chaff.
As I stated at the beginning of my reply, DRP's are here to stay for a while. What can we, the property adjusting community (both IA and PA alike) do to insure that our livelihoods continue in this atmosphere of DR programs?
SIMSOL sells its software to all of the above mentioned professions. I belive that DRP's do have their place but for only certain types of losses, at certain dollar levels. I shutter to think of DRP's estimating cat losses but I have heard rumblings that some carries will be relying on their DRP contractors as at least part of their "major catastrophe" strategies. |
Gale
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:28 am: | |
I thought it was interesting that Paul Davis after selling Paul Davis Systems 5 years ago and started PCS (Property Claims Solutions) now makes sure all losses are scoped by an licensed IA’s and the contractor agrees to work from that estimate and only has 3 working days to discover hidden damages. This man started out as a contractor. |
Olderthendirt
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:27 am: | |
Wong, under the prefered contractor program often the contractor is the only contract the insured has with the company. It would seem to me that if the contractor discuses coverage or claims settlement then he is adjusting. When an expert is sent out he does his job reports and bills. The adjuster then tells the insured the results. While the contractor will not skate over the line on every file, it will happen on many. |
DWongWhey
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:26 am: | |
Scoping a loss and writing an estimate does not rise to the level of being the same as adjusting the loss. Many large losses and a majority of commercial losses are customarily estimated by licensed contractors on behalf of adjusters and carriers. This is most especially true when a general adjuster is involved in handling an extermely large and complicated loss, whether the general adjuster is carrier or independent.
I am not ignorant of the laws here in Hawaii, and to the contrary, believe that any expert sent to scope a loss, determine values including salvage, inventory or replacement is exempt from the Hawaii licensing statutes and insurance regulations as long as the file is handled, supervised and concluded by a licensed adjuster.
Think what you may, but I'll bet a large basket of fresh pineapple against a bushel of your Florida oranges, that in the end, the insurance commissioners in any of the states interpret the statutes and regulations along the lines I am suggesting.
We obviously see this issue from two quite different standpoints based upon whatever self-serving inherent bias which we each share. In the end, the position you advocate will prove correct or incorrect and largely it will be and remain beyond our individual or collective influence or control.
Thanks for your clarification and for more fully expounding on the basis for your position.
By the way Papa Roy-san I much prefer this new format for the Forum. Nice change which is well presented and easy to work with as well. |
wscook
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:25 am: | |
I had a concern that the grass skirts may have diverted the attention of your legislators but a quick review of the statutes indicates that you may be misinformed about your home state's concern for folks adjusting claims without a license.
In looking at statutes in Hawaii it appears that an adjuster sending out a contractor to conduct the business of insurance without a license may here those famous HAWAIIAN words... "BOOK EM DANNO"
William S Cook
Public Adjuster
ADJUSTER DEFINED IN HAWAII
§431:9-105 Adjuster defined. (a) Adjuster means any individual who:
(1) Acts solely on behalf of either the insurer or the insured, as an independent contractor or as an employee of an independent contractor; and
(2) Investigates for, reports to, or adjusts for the individual's principal relative to claims arising under insurance contracts.
(b) Independent adjuster means an adjuster representing the interests of the insurer.
(c) Public adjuster means an adjuster employed by and solely representing the financial interests of the insured named in the policy.
(d) For the purposes of this article, the following individuals are not deemed to be an adjuster:
(1) An attorney at law who adjusts insurance losses from time to time incidental to the practice of the attorney's profession;
(2) An adjuster of marine losses;
(3) A salaried employee of a general agent, a subagent, an insurer, or of an adjusting corporation or association owned and controlled by insurers; and
(4) An individual who acts for a self-insurer or for an insured which administers its own group insurance contract.
(e) Following a catastrophe in this State, a Hawaii license shall not be required of a nonresident independent adjuster for the adjustment of losses; provided:
(1) The common losses suffered that are to be adjusted are a direct result of that catastrophe;
(2) The adjuster provides to the licensing branch of the insurance division a certified copy of the adjuster's current license in another state. That other state shall have similar licensing requirements to section 431:9-222; and
(3) That within three working days of when the nonresident independent adjuster begins work, the insurance company, independent adjusting company, general agent, or subagent that is utilizing the adjuster shall provide on its letterhead to the licensing branch of the insurance division:
(A) The name of the adjuster;
(B) The adjuster's Hawaii mailing and business addresses and phone numbers; and
(C) The adjuster's permanent home and business addresses and phone numbers.
For the purpose of this subsection, a catastrophe exists when due to a sudden, specific, and natural or manmade disaster or phenomenon, there arises property losses in Hawaii that are covered by insurance. These losses must be so severe that resident licensed and independent adjusters will be unable to adjust the losses within a reasonable time as determined by the division.
(f) Upon satisfaction of all the requirements in subsection (e), the nonresident independent adjuster may be registered with the licensing branch of the insurance division and adjust catastrophic losses in this State for up to one hundred twenty days from the date of registration or for a period of time determined by the commissioner, whichever is less. [L 1987, c 347, pt of §2; am L 1997, c 83, §2; am L 2000, c 182, §8]
§431:9-222 Qualification for adjuster's license. (a) To qualify for an adjuster's license, an applicant shall comply with this article and shall:
(1) Be domiciled in this State, or in a state which will permit residents of this State to act as adjusters in such other state;
(2) Have had experience, special education, or training with reference to the handling of loss claims under insurance contracts, of sufficient duration and extent reasonably to make the individual competent to fulfill the responsibilities of an adjuster;
(3) Have successfully passed any examination required under section 431:9-206; and
(4) Have paid the license fee.
§431:9-229 Records of general agent, subagent, adjuster, independent bill reviewer. [Section effective until June 30, 2002. For section effective July 1, 2002, see below.] (a) Every adjuster or independent bill reviewer shall keep a record of all transactions consummated under their license. This record shall be in organized form according to class of insurance and shall include:
(1) If an adjuster, a record of each investigation or adjustment undertaken or consummated, and a statement of any fee, commission, or other compensation received or to be received by the adjuster on account of the investigation or adjustment;
PART II. LICENSING REQUIREMENTS, PROCEDURES AND ENFORCEMENT
§431:9-201 License required. [Section effective until June 30, 2002. For section effective July 1, 2002, see below.] (a) No person engaging in the business of insurance in this State shall act as, be appointed as, or hold oneself out to be a general agent, subagent, solicitor, adjuster, or independent bill reviewer unless so licensed by this State.
(b) No general agent, subagent, or solicitor in this State shall solicit or take applications for, procure, or place for others any class of insurance for which the general agent, subagent, or solicitor is not licensed and does not hold an appointment from the insurer in this State for that class of insurance.
(c) A regular salaried officer or employee of an authorized insurer shall not be required to be licensed by reason of rendering assistance to, or on behalf of a licensed general agent, subagent, or solicitor, provided that the salaried officer or employee devotes substantially all of the officer's or employee's time to activities other than the solicitation of applications for insurance or annuity contracts and receives no commission or other compensation directly dependent upon the amount of business obtained.
(d) Any person violating this section shall be assessed a civil penalty not to exceed $5,000 for each factually different violation.
(e) Any person who knowingly violates this section shall be assessed a civil penalty of not less than $1,000 and not more than $10,000 for each violation.
(f) Each repetition of an act that constitutes a violation subject to subsection (d) or (e) shall constitute a separate violation. [L 1987, c 347, pt of §2; am L 1993, c 205, §14; am L 1998, c 203, §1; am L 2000, c 182, §9 and c 288, §7]
§431:9-201 License required. [Section effective July 1, 2002. For section effective until June 30, 2002, see above.] (a) No person engaging in the business of insurance in this State shall act as, be appointed as, or hold oneself out to be an adjuster or independent bill reviewer unless so licensed by this State.
(b) Any person violating this section shall be assessed a civil penalty not to exceed $5,000 for each factually different violation. |
wscook
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:23 am: | |
The legislature wrote the statutes, rest assured Florida Department of
Insurance consider their duties without mirth. Here are some to consider. It is far from a scheme it is the law.
William S Cook
Public Adjuster
ADJUSTER DEFINITION DOES NOT MENTION CONTRACTOR IN FLORIDA
626.101 "Adjuster" defined.--For the purposes of this part, an "adjuster" means a public adjuster, independent adjuster, or company employee adjuster, as respectively defined in part VI.
626.103 "License" defined.--A "license" is a document issued by the department authorizing a person to be appointed to transact insurance or adjust claims for the classes of insurance identified in the document.
******************************************************
626.112 License and appointment required; agents, customer representatives, solicitors, adjusters, insurance agencies, service representatives, managing general agents.--
(1) No person shall be, act as, or advertise or hold himself or herself out to be an insurance agent, customer representative, solicitor, or adjuster unless he or she is currently licensed and appointed.
(2) No agent, customer representative, or solicitor shall solicit or otherwise transact as agent, customer representative, or solicitor, or represent or hold himself or herself out to be an agent, customer representative, or solicitor as to, any kind or kinds of insurance as to which he or she is not then licensed and appointed.
(3) No person shall act as an adjuster as to any class of business for which he or she is not then licensed and appointed.
****************************************
626.611 Grounds for compulsory refusal, suspension, or revocation of agent's, title agency's, solicitor's, adjuster's, customer representative's, service representative's, or managing general agent's license or appointment.--The department shall deny an application for, suspend, revoke, or refuse to renew or continue the license or appointment of any applicant, agent, title agency, solicitor, adjuster, customer representative, service representative, or managing general agent, and it shall suspend or revoke the eligibility to hold a license or appointment of any such person, if it finds that as to the applicant, licensee, or appointee any one or more of the following applicable grounds exist:
(1) Lack of one or more of the qualifications for the license or appointment as specified in this code.
(2) Material misstatement, misrepresentation, or fraud in obtaining the license or appointment or in attempting to obtain the license or appointment.
(3) Failure to pass to the satisfaction of the department any examination required under this code.
(4) If the license or appointment is willfully used, or to be used, to circumvent any of the requirements or prohibitions of this code.
(5) Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract, done either in person or by any form of dissemination of information or advertising.
(6) If, as an adjuster, or agent licensed and appointed to adjust claims under this code, he or she has materially misrepresented to an insured or other interested party the terms and coverage of an insurance contract with intent and for the purpose of effecting settlement of claim for loss or damage or benefit under such contract on less favorable terms than those provided in and contemplated by the contract
*************************************
626.855 "Independent adjuster" defined.--An "independent adjuster" is any person who is self-employed or is associated with or employed by an independent adjusting firm or other independent adjuster, and who undertakes on behalf of an insurer to ascertain and determine the amount of any claim, loss, or damage payable under an insurance contract or undertakes to effect settlement of such claim, loss, or damage.
*626.856 "Company employee adjuster" defined.--A "company employee adjuster" is a person employed on an insurer's staff of adjusters, and who undertakes on behalf of such insurer or other insurers under common control or ownership to ascertain and determine the amount of any claim, loss, or damage payable under a contract of insurance, or undertakes to effect settlement of such claim, loss, or damage.
*******************************************************************
624.317 Investigation of agents, adjusters, administrators, service companies, and others.--If it has reason to believe that any person has violated or is violating any provision of this code, or upon the written complaint signed by any interested person indicating that any such violation may exist, the department shall conduct such investigation as it deems necessary of the accounts, records, documents, and transactions pertaining to or affecting the insurance affairs of any:
(1) General agent, surplus line agent, adjuster, administrator, service company, or other person.
*********************************************
********************************************
(i) Unfair claim settlement practices.--
1. Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured;
2. A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy; or
3. Committing or performing with such frequency as to indicate a general business practice any of the following:
a. Failing to adopt and implement standards for the proper investigation of claims;
b. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue;
c. Failing to acknowledge and act promptly upon communications with respect to claims;
d. Denying claims without conducting reasonable investigations based upon available information;
e. Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed;
f. Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement;
g. Failing to promptly notify the insured of any additional information necessary for the processing of a claim; or
h. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. |
wscook
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:21 am: | |
Mr. Whey
Responding to your logic.
Just because a contractor has supervision from a licensed adjuster it can not mean that the insured will get all of his entitlements under the policy. If one assumes that the contractor is a licensed professional in his field of determining what he considers a fair compensation for his work, could have many outside influences. If he were flush with work and the insured told him that he was going to get his handyman to patch things up he will write it on the low side if he knows he will not get the job. He may send his brother-in-law out to measure it and bring the figures and photos back to the office. He may get in cahoots with the insured and inflate it to cover some pre existing condition that will help him get the job. He may write it low to get the job but with the assurance that he will be protected on any supplements if he gets the job. Since he can not be held accountable to any Department of Insurance people he could mistakenly say, "insurance company will not pay for that so no need to put it down." The adjuster back at the office busy supervising twenty other contractors will never see that the contractor made a wrong coverage call. I think I could name a few more scenarios that could give pause to sending out a contractor to establish the insurance company obligation. Why not let the fireman that was surely there first voluntarily give his time to list all the damage for the insurance company as long as he was supervised plus he is already at the scene so no mileage is owed. That would not make it any more competitive to the contractor since they to are gratuitously traveling to the scene to write estimates. Would your approval extend to insurers sending out only licensed contractors? What if they only have a roofing contractor license? What if the contractor comes to Hawaii on the next hurricane with an Alabama contractor pricing schedule in his computer? Why not allow the insured to get paid on "his" contractor's estimate as long as the adjuster supervises him or has supervised him in the past.
Certainly engineers, cause and origin, and other experts have a right to respond to bring their expertise to the supervising adjuster. But the insurance company will pay them for their expertise. They will not be involved in adjusting the claims or considering coverage issues.
I know you enjoy controversial issues such as this but legislatures in many states have already had the foresight to draft statutes that protect the insureds from economy driven insurance companies. They should structure their rates to accommodate the loss ratios as well as the administrative cost of being in the insurance business. The administrative cost includes paying competent and trained people to process the losses that may arise.
William S Cook
Public Adjuster
in Orlando
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DWongWhey
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:20 am: | |
Cute answer Mr.Cook.
Not very logical as you say, but cute nevertheless.
Now perhaps you can quote some Florida law or a Florida administrative regulation which would prevent an 'expert' from assisting a supervising adjuster in handling a claims file?
I mentioned that we may not like this, but if we look critically without a bias, we would see how silly a complaint would appear to the insurance department in any particular state.
I for one, don't think you are going to get anywhere with this scheme, other than to give some false hope to lots of adjusters here who cannot see for having their blinders on.
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wscook
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:19 am: | |
Mr. Whey
Responding to your logic.
Just because.
William S Cook
Public Adjuster |
DWongWhey
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:18 am: | |
If the claim is under the supervision of a licensed adjuster what would be the difference between the supervising adjuster sending out a contractor to scope and estimate the loss for the carrier and sending out a professional engineer or other specialty expert for an opinion as to cause and origin or a salvage expert.
For the life of me, as long as there is a licensed adjuster supervising the claim file and handling the liability issues within the policy, as much as we may not like the process, I can see nothing illegal about the continuation of the DRP program.
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Tom Toll
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:17 am: | |
I would think that it would be considered a conflict of interest if home contractors/repair contractors got an adjusters license. I am in hopes this goes somewhere. It is making some contractors very wealth in my state and putting a number of good adjustment firms in jeopardy, business wise.
Tom Toll
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olderthendirt
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:16 am: | |
To ofeten the regulators mumble something about unclear. but this is something pro-active, if nothing else we'll make the adjsuting schools rich while the contractors rush to get licenced |
Dave
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:15 am: | |
 This is where the adjusting community is. BEHIND the 8 ball.
The use of the DRP program or any other contractor to inspect, adjust and settle claims is as Mr. Cook alluded, an infringement of at least some laws of some states. Which just so happens to deprive the adjusting community of an income, be they Staff, Independent, or Cat Adjusters.
Presently, we are gathering some very valuable information that will rock the boat of the DRP's and the carriers that use them.
The next "Katt's Report" will detail a small but revealing aspect of this program.
"Caveat Emptor"
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wscook
Unregistered guest
Posted From: 209.179.128.246
| | Posted on Sunday, January 27, 2002 - 11:11 am: | |
Florida statutes indicate that only the services of a licensed adjuster can be used to establish the liability of insurers for property damage losses. We are currently involved in two formal complaints against insurers that have utilized this practice to establish their obligation under the contract of insurance. We intend to file a complaint each time we find insurers guilty of this practice. We opine that many other states have similar statutes on the books that those laws should be proactivly utilized to make licensed adjusters the first responders to a property loss rather than an insurance friendly contractor. This practice contributes to the watering down of the available work for qualified adjusters. If it is an illegal practice in your state it should not be allowed to interfere with your ability to make a living. If the insurers can use this illegal practice in a non-catastrophe situation for economy purposes on small losses, they will continue to increase the amount of loss dollar thresholds, and fewer licensed adjusters will be called to the next major event. If insureds choose a contractor to evaluate their loss for submission to insurers, then contractors are well within their contractors licensing authority to act in that capacity. X-(
William S Cook
Public Adjuster |
Admin
Moderator
Username: Admin
Post Number: 77
Registered: 1-2002
| | Posted on Sunday, January 27, 2002 - 1:47 am: | |
I have not had a chance to move this thread yet from the test area, so if you wish to view and \or post follow this link http://www.catadjuster.org/forum/topic.asp?TOPIC_ID=9 |
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